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NPI Code Detail

MEDICARE: DR. MARK TRAHAN M.D.

MEDICARE: DR. MARK TRAHAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician304164LA

General Provider Information

NPI Number : 1679872568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK TRAHAN M.D.
Provider Business Mailing Address
First Line : 1800 RYAN ST STE 105
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-6078
Country : US
Telephone Number : 337-439-4706
Fax Number :
Provider Business Practice Location Address
First Line : 3704 NORTH BLVD STE 1
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-3673
Country : US
Telephone Number : 225-773-4726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2011
Last Update Date : 01/15/2025

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